Differential Diagnosis
- Single most likely diagnosis
- Perimenopause: The patient's symptoms of hot flashes, fatigue, and mood changes (feeling "extremely cranky") are consistent with perimenopause, a transitional phase leading up to menopause. The irregular menstrual cycle and recent cessation of hormonal contraception also support this diagnosis.
- Other Likely diagnoses
- Premenstrual dysphoric disorder (PMDD): The patient's symptoms of bloating, mood changes, and fatigue occur intermittently and may be related to her menstrual cycle, suggesting PMDD.
- Anxiety or depression: The patient's symptoms of fatigue, mood changes, and missing work could also be indicative of an underlying anxiety or depressive disorder.
- Thyroid dysfunction: Fatigue, mood changes, and hot flashes can also be symptoms of thyroid dysfunction, such as hypothyroidism or hyperthyroidism.
- Do Not Miss
- Pregnancy: Although the patient has undergone bilateral tubal ligation, it is essential to rule out pregnancy, as ectopic pregnancies can occur.
- Adrenal insufficiency: Fatigue, hot flashes, and mood changes can be symptoms of adrenal insufficiency, a life-threatening condition if left untreated.
- Pituitary tumor: A pituitary tumor can cause hormonal imbalances, leading to symptoms such as hot flashes, fatigue, and mood changes.
- Rare diagnoses
- Polycystic ovary syndrome (PCOS): Although the patient's symptoms do not fully align with PCOS, it is a possible diagnosis to consider, especially if she has a history of irregular menstrual cycles and hyperandrogenism.
- Hyperparathyroidism: This rare condition can cause symptoms such as fatigue, mood changes, and hot flashes due to hypercalcemia.